Claims and Licensing Board Complaints


What is a claim?

A claim is demand for money. The most obvious example is when you are being sued. From time to time a client gets angry with you. However, it is not a claim until you have a demand for money.

What is a licensing board investigation?

A licensing board investigation is any investigation by your state licensing board. If the board contacts you and it is not a part of your standard license renewal then it is an investigation.

What is the difference between a formal and an informal investigation by the licensing board?

Nothing. Licensing boards are mindful of the stigma of a formal investigation so when they receive a complaint or decide to investigate a psychologist, they first like to gather information. The licensing board or its investigator may call this initial phase an informal investigation or indicate that they are only asking questions and have not started a formal investigation. Regardless of what the action is called, the psychologist should take all actions by the board seriously and treat them as a formal complaint.

What should I do if I think I have a claim or board complaint?

Call Trust Risk Management Services (TRMS) at 877-637-9700. Talk to a licensed professional and let them help you determine the best course of action. You will not jeopardize your coverage for asking if you have a claim or investigation. TRMS may help you use your coverage to its fullest advantage or point you to resources you may not have been aware you had.

How much time do I have?

Timing is crucial. When you receive a claim or are under investigation by your licensing board, you often have a limited time to respond. Normally you will have from two weeks to one month. The sooner you report the situation, the sooner someone can help you prepare a response. Often your attorney will need most of that time to help you craft the best defense. Any delay in reporting hurts your defense and limits the time your attorney has to help you.

What should I do if I know I have a claim or am being investigated by my licensing board?

You should report it to TRMS immediately. The carrier is going to require that the report be in writing, so you should prepare a cover page that lists your name, the date, and your policy number. Address the cover page to Attn: Claims Department. You should include the claim letter, subpoena or letter from the licensing board. Because time is of the essence, most people prefer to fax it to 877-251-5111. If you do not have access to a fax then you can mail it to: Trust Risk Management Services, Inc., 1791 Paysphere Circle, Chicago, IL 60674.

What does my policy do if I have a claim?

If you are being sued for a covered claim, the insurance company defends you. You notify the carrier that you have been sued. A claims manager from the carrier will contact you in one to two business days. The claims manager will assign you an attorney to defend your case. Since the policy covers defense costs, you do not need to pay the attorney.

What do I do if I have a licensing board complaint?

Licensing board complaints are handled differently than claims. You still report to TRMS that your licensing board has contacted you. The difference is that you hire an attorney to defend you and the carrier reimburses you for reasonable expenses. Licensing board complaints are not like lawsuits, so you will want to hire an attorney accustomed to defending psychologists before licensing boards. Your local psychological association may be able to help you determine which attorneys are most successful with the licensing boards.

I did not do anything wrong. Do I really need a lawyer to respond to a licensing board investigation?

The licensing board is there to protect the consumer, not the psychologist. The investigator if often not a psychologist, and he or she asks questions within a narrow interpretation of the law. You need the experience of an attorney familiar with licensing board investigations. Even seemingly innocuous questions can be fraught with pitfalls for a psychologist unfamiliar with licensing board investigations.

Is there anything wrong with handling a claim yourself?

The most important portion of your coverage is the legal defense. Each year the carrier spends more on defense than on paying damages. The carrier is experienced at handling claims to your benefit. However, they cannot help you if they are not aware of the claim. If you do not report your claim promptly, you compromise your defense and by extension jeopardize your coverage. When you interfere with the carrier's ability to properly defend a claim, you have violated the terms of you policy and the carrier can deny coverage.

Back to top

For more detailed answers, or if your question was not answered here, please call us at 1-800-477-1200.